Practice Patterns of the Medical Evaluation of Living Liver Donors in the United States.
Academic Article
Overview
abstract
Living donor liver transplant (LDLT) can help to address the growing organ shortage in the United States (US), yet little is known about the current practice patterns in the medical evaluation of living liver donors. We conducted a 131-question survey of all 53 active LDLT transplant programs in the US to assess current LDLT practices. The response rate was 100%. Donor acceptance rate was 0.33 with interquartile range of 0.33-0.54 across all centers. Areas of high inter-center agreement included minimum age cut off of 18 years (73.6%) and exclusion of those with greater than class 1 obesity (BMI 30.0 - 34.9 m/kg2) (88.4%). Diabetes was not an absolute exclusion at most centers (61.5%). Selective liver biopsies were performed for steatosis or iron overload on imaging (67.9% and 62.3% respectively) or for elevated liver enzymes (60.4%). Steatohepatitis is considered an exclusion at most centers (84.9%). The most common hypercoagulable tests performed were Factor V Leiden (88.5%), Protein C (73.1%), Protein S (71.2%), Antithrombin II (71.2%), and prothrombin gene mutation (65.4%). At 41.5% of centers, donors were allowed to proceed with donation with Factor V Leiden heterozygote status. Most programs discontinue oral contraceptive pills at least 28 days prior to surgery. At most centers, need for cardiovascular ischemic risk testing is based on age (73.6%) and the presence of one or more cardiac risk factors (68.0%). Defining areas of practice consensus and variation underscore the need for data generation in order to develop evidence-based guidance for the evaluation and risk assessment of living liver donors.
